While no chronic illness is easy to navigate, individuals afflicted with diabetes are recognized as having a notably stressful and high-maintenance disease.
Dr. Rashmi Mullur, an endocrinologist and integrative medicine expert with UCLA Health and the Greater Los Angeles Veteran’s Administration (VA) is very focused on diabetes and its relationship to stress. “That is the stress from living with diabetes,” she said.
The stress from living with diabetes “has to do with the overall emotional [and] mental burden of living with diabetes,” Mullur explained. This includes “having to check your sugar, having to worry about ‘Do I have something [on hand] in case [my blood sugar drops] low?’ or ‘Oh I’m not feeling right, is it my blood sugar?’”
“It’s that constant [news] chyron if you will, going through the diabetic patient’s head,” she said. It can be overwhelming and all-encompassing.
Mullur’s approach to diabetic care is “meeting my patients and see[ing] how [I] can help them with their diabetes, where they are at [in managing the disease].” From that point, she can make suggestions as to how the patient can adjust his or her lifestyle, or prescribing or adjusting medications.
She has experienced and been there for diabetic patients through the uncharted territory of the Covid-19 pandemic which added an additional layer of stress.
Mullur said she listened to patients and helped them navigate as they told her things like, “I don’t have time to check my sugar, because I don’t have a minute to myself, because I’m taking care of my kids all day and they are on remote school” or “I’m so stressed out, I can’t even think about my diabetes.”
Like Mullur said, she meets patients “where they are at.” Treatment is not uniform, conversations vary from patient to patient, and she approaches care on an individual basis – not on a global scale.
Mullur defined her focus “on assessing the diabetes-related distress and then seeing what mind-body approaches can [be] used to target [and improve] that.”
Mullur developed a clinic to help diabetic patients with their stress levels and published results of the small pilot study. This was by “teaching patients a 10-minute seated yoga program,” which proved successful helping “patients have a better morning blood sugar reading.”
The group clinic consisted of 50 participants and was conducted at UCLA. She informed the patients “about the stress response; [they] set some smart goals; and she taught them a seated yoga practice and a 5-minute mindfulness practice.” The outcome was positive.
Mullur said, “We were able to show that at 3 months, 6 months, and 1 year, we were able to keep their A1C a point down.” Diabetics are very familiar with an A1C test. It is a blood test typically run every three months on a diabetic that shows a three-month average of their blood sugar level, versus, a “one-time” snap test that only reflects the sugar reading for that point in time.
The benefits of a mind-body approach are limitless when it comes to chronic disease. Mullur’s approach is something that can be taught once since patients can be provided with some tools and have the flexibility to incorporate the routine on their own time.
“I think these mind-body techniques are safe; they are easy to incorporate and for the most part, they have the most [positive] data [insofar as improving health],” Mullur noted.
In addition to benefiting a patient’s A1C level, they also can prove beneficial to other conditions a patient is living with. Cardiovascular disease would be one of the most concerning ones. “These mind-body techniques have been shown to help cardiovascular disease,” she said. “You’re not only helping the diabetes, but also helping to prevent complications.”
It did not impact patients’ meal time blood sugar level, which Mullur said, “makes sense because a mind-body approach is not necessarily going to change the sugar you absorbed from the carbs that you eat, but it will help that overall baseline blood sugar be [slightly] lower so when you wake up in the morning you might wake up with a better blood sugar [reading].”
An important thing to note is that this isn’t an aggressive, 60-minute standing, wear-yourself-out yoga. Its “gentle and can be approached by anyone” yoga, she said.
“Diabetes related to stress is the overwhelming [aspect] of diabetes,” and Mullur said it can help “the emotional burden and kind of feeling like no one else understands.”
While a popular topic, Mullur noted that supplements “have a much lesser role in the improvement of diabetes than the mind-body techniques.”
Living with chronic disease has many facets. “Sometimes [patients] learn to ignore certain symptoms just to kind of get through the day,” Mullur said. She explained this as, in order to survive, some patients develop a kind of benign neglect.
As an example, Mullur used a person who lives with chronic back pain. “Very rarely are you going to be able to not work, financially you might still have to, so you develop a benign neglect so that you can get through the day.”
I find this to be very true for myself and for family members, friends, and people I’ve met who are struggling with a variety of illnesses.
When asked what the most under-represented piece of information or advice out there that could benefit a pre-diabetic, diabetic, or someone serving as a caregiver of one, Muller said, “I think it’s really understanding the stress response related to blood sugar.”
“If you’re trying to [have] a healthy lifestyle, it’s not just about eating right, exercising, getting to the gym and pushing to your limit, and being exhausted and worn out by the end of the day,” she said.
Mullur said she would “rather have my patients less stressed out, less burnt out; maybe they didn’t make it to the gym that day, and maybe the only thing they did that was healthy was skip dessert.”
Simply put, “that’s still a lifestyle choice and I’ll take that,” she said. “I would rather have patients not burnt out, not stressed out not feeling like they are running on empty.”
As we with health conditions know, being burned out, stressed out, and running on ‘low’ has the ability to transcend / maneuver itself into many aspects of your life. And typically not for the better.
Running on empty “promotes a stress response in the body,” Mullur said. “It makes it much harder for patients to feel effective in terms of making other changes and it decreases their ability to cope long-term.”
“That I think is the most underrepresented thing we should be focused more on,” she said.
“We need to be focused on health and health really comes from the sense of feeling whole,” Muller said. “And whole across the board – mind, body, spirit. Not just mind, body, and I’m exhausted at the end of the day and crash out.”
“We want patients to feel full in their lives and sometimes chronic disease takes us away from that,” she said.
*Source: 2020 National Diabetes Statistics Report, Estimates of Diabetes and its Burden in the United States.
Coming next: Pain, pain tolerance, and the 1-10 pain scale
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